What is a breast prosthesis?

A breast prosthesis is an artificial breast form that fits in a bra cup to replace your natural breast. It is most often used after surgery for breast cancer, either after a mastectomy or bi-lateral mastectomy (removal of one or both breasts), or a wide local excision (removal of a lump and some surrounding tissue). It can also be used following other surgery to the chest area or if your breasts are unevenly developed. A well fitting prosthesis can make you feel balanced and give you a more normal shape.

Most prostheses are made from silicone gel moulded to form the natural shape of a woman's breast, or part of a breast. Sometimes they include the nipple outline. The top surface of the prosthesis feels soft and smooth. The surface that rests against the skin varies. It can be firm and smooth, flat or hollow, have ridges that are soft and pliable, or be made of fabric.

A silicone prosthesis may feel cold at first but it warms up quickly with body contact. It may also seem heavy, but the sense of weight should disappear once it is held against your chest wall and supported by a well fitting bra.

Can I wear a prosthesis straight after surgery?
You will not be able to wear a silicone prosthesis for about six to eight weeks after your surgery. This is because your wound needs time to heal. During this time you can use a soft prosthesis.

When the scar has fully healed you can wear a silicone prosthesis. However, if you are having further treatment your choice may be limited for a time. For example, radiotherapy can make the skin tender and sensitive so that you may not be able to wear a silicone prosthesis until this sensitivity has gone completely.

Some women find that a bra is too constricting during this time. If you prefer, you can wear a camisole top or a seamless cotton vest with Lycra to give you support.

Getting a prosthesis
To enable you to choose the right prosthesis you need to have a well fitting bra and be seen by a fitter. You also need plenty of time and privacy. You might find it helpful to look at some breast prostheses so that you have an idea of what to expect, perhaps even before your operation. Your breast care nurse can show you some samples of different prostheses.

Choosing a bra
To make sure that your prosthesis is comfortable and fits well you need to have a well fitting bra. This doesn't necessarily mean that you will need to buy a new one. A well fitting bra (which may be underwired): 

• has full cups with firm elasticated edges
• fits close to your chest wall between the cups with a high front at the centre
• has elasticated, adjustable straps for comfort and support. You should be able to find suitable bras in high street shops although you can also buy them by mail order

If you are going to buy a new bra it is best to see a trained bra fitter, even if you think you know your bra size. Most lingerie shops and department stores have trained fitters and some have had had special training to fit women who have had breast surgery. It may be worth explaining your situation in advance or booking an appointment to see someone to make the experience as comfortable as possible.

Although you can get a good result with a normal, well fitting bra, some women feel more secure with a mastectomy bra, which may have a pocket in the cup to hold the prosthesis. You can buy mastectomy bras in lingerie shops, department stores and by mail order. You can also adapt an ordinary bra by sewing in a pocket. You can buy pockets from mail order suppliers and some hospitals will pay for pockets to be sewn into your bra.

At the fitting
The breast care nurse or appliance officer at the hospital may do the prosthesis fitting for you. An appointment may be made for you before you leave hospital. When you get fitted for your prosthesis it is a good idea to wear or take with you a plain, light-coloured T-shirt or top. This makes it easier to choose a prosthesis that gives you a smooth outline. You may also want to take a favourite bra or a low-necked dress that you would still like to wear. It is best not to wear a black bra as the colour makes it more difficult to see how well the prosthesis fits. It can also be helpful to take a friend or partner along for support and to give a second opinion.

Different types of prostheses
There is an extensive range of prostheses available in different shapes, sizes and skin colours. A prosthesis can be full, partial or 'shell'. You should be able to find a prosthesis to suit your particular needs, for example the shape you are and the type of surgery you have had.

Soft prostheses
This is a light prosthesis made of synthetic washable fibre inside a cotton cover. It is most commonly used in the weeks after surgery, although you might decide to carry on using this type of prosthesis in the long term.

Partial prostheses
You may need a small, specially shaped prosthesis to fill out the bottom, top or side of your bra. For example, if you have had a wide local excision you may not have lost much breast tissue but it may be enough to make your breast shape different. This will depend on the size of your breast and where the lump was, and will affect the type of prosthesis you need.

'Shell' prostheses
A 'shell' type prosthesis is hollow and fits over any remaining breast tissue, restoring your breast to its original shape and size. It can be used if you have had a wide local excision or sometimes if you have had a breast reconstruction. For example, gaining weight can increase the size of your natural breast so that you need a prosthesis to increase the size of your reconstructed breast.

Lightweight prostheses
Most prostheses are made to weigh the same as your normal breast, although some women find that these still feel too heavy. You may prefer to wear a lightweight prosthesis. These are also made of silicone but they weigh less than standard prostheses because they contain more air. Or they can be made up of a fabric cover containing a silicone shell filled with lightweight padding. Lightweight prostheses can be particularly useful for women with lymphoedema (swelling caused by a build-up of lymph fluid in the surface tissues of the body).

Self-supporting prostheses
Self-supporting prostheses may suit some women, particularly those who are very active. These prostheses stick directly to your skin so they feel more natural and secure than other types which simply fit into a bra cup (although they still need the support of a well fitting bra). Some prostheses can be made self-supporting by using adhesive strips that stick to the back of the prosthesis and to your skin. It is not advisable to wear a self-supporting prosthesis while you are having radiotherapy because the skin is sensitive during this time.

Foam/swimming prostheses
These lightweight prostheses are made from foam or silicone and specially designed for swimming or sports. (You may find that your normal prosthesis is suitable for these activities.)

Prosthetic nipples
Prosthetic nipples are artificial nipples in different sizes and skin colours that you can stick on to your breast prosthesis. You can also have a custom-made nipple to match the nipple on your other breast. To find out more about the different options, talk to your breast care nurse or prosthesis fitter or look at supplier catalogues.

How do I look after my prosthesis?
It is important to look after your prosthesis carefully and follow the care instructions that come with it. Generally, most prostheses should be washed every day with warm soapy water and patted dry with a towel. Always keep your prosthesis in its box when you are not wearing it so that it doesn't get damaged. Silicone prostheses are not harmed by salt or chlorinated water as long as they are rinsed in clean water afterwards. Prostheses are generally guaranteed for two years, as long as the care instructions have been followed, but often last longer.

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